Evaluation of the operationalization of health promotion in primary health care
1
Department of Public Health, Federal University of Santa Catarina, Santa Catarina/ Florianópolis, Brazil
2
Department of Public Health/Faculty of Health Sciences, University of Brasília, Federal District, Brasília, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1480
ABSTRACT
INTRODUCTION:
Health Promotion, although strategic within Primary Health Care (PHC) of Brazil’s Unified Health System (SUS) for addressing social determinants, faces operational and evaluative challenges1-4. Thus, this study aimed to assess the operationalization of Health Promotion in Primary Health Care of SUS.
METHODS:
This is a mixed-methods evaluative study with an implementation analysis across different contexts5, conducted from 2023 to 2025 in two stages: an evaluability study6, including document analysis, literature review, theoretical-logical modeling, and the development and validation of an evaluative matrix; and a multiple case study in three PHC Units in a municipality in southern Brazil, selected according to the Brazilian Deprivation Index. Data collection included questionnaires and semi-structured interviews with professionals and managers. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed through Content Analysis7, supported by ATLAS.ti® software.
RESULTS:
The evaluative model comprised four dimensions, 17 subdimensions, 45 indicators, and 84 measures, with classification of the degree of operationalization ranging from incipient to advanced. Its application revealed weaknesses in Health Promotion, particularly in intersectoral action, the rational use of medicines, physical activity practices, and the addressing of tobacco, alcohol, and other drug use, in addition to structural limitations. Interviews revealed a restricted conception of Health Promotion, often associated with prevention, as well as barriers such as low institutionalization, inequalities in access, and a focus on spontaneous demand. Notably, the unit located in a high-deprivation area showed better performance, indicating that work organization, team articulation, and participatory strategies were more determinant than resource availability.
CONCLUSIONS:
Health Promotion actions in PHC show an intermediate level of operationalization and rely largely on individual initiatives, compromising their sustainability. The evaluative model demonstrated robustness and applicability, with potential to strengthen planning, monitoring, and evaluation of practices, contributing to the reduction of vulnerabilities and the promotion of health equity.
Health Promotion, although strategic within Primary Health Care (PHC) of Brazil’s Unified Health System (SUS) for addressing social determinants, faces operational and evaluative challenges1-4. Thus, this study aimed to assess the operationalization of Health Promotion in Primary Health Care of SUS.
METHODS:
This is a mixed-methods evaluative study with an implementation analysis across different contexts5, conducted from 2023 to 2025 in two stages: an evaluability study6, including document analysis, literature review, theoretical-logical modeling, and the development and validation of an evaluative matrix; and a multiple case study in three PHC Units in a municipality in southern Brazil, selected according to the Brazilian Deprivation Index. Data collection included questionnaires and semi-structured interviews with professionals and managers. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed through Content Analysis7, supported by ATLAS.ti® software.
RESULTS:
The evaluative model comprised four dimensions, 17 subdimensions, 45 indicators, and 84 measures, with classification of the degree of operationalization ranging from incipient to advanced. Its application revealed weaknesses in Health Promotion, particularly in intersectoral action, the rational use of medicines, physical activity practices, and the addressing of tobacco, alcohol, and other drug use, in addition to structural limitations. Interviews revealed a restricted conception of Health Promotion, often associated with prevention, as well as barriers such as low institutionalization, inequalities in access, and a focus on spontaneous demand. Notably, the unit located in a high-deprivation area showed better performance, indicating that work organization, team articulation, and participatory strategies were more determinant than resource availability.
CONCLUSIONS:
Health Promotion actions in PHC show an intermediate level of operationalization and rely largely on individual initiatives, compromising their sustainability. The evaluative model demonstrated robustness and applicability, with potential to strengthen planning, monitoring, and evaluation of practices, contributing to the reduction of vulnerabilities and the promotion of health equity.
| eISSN: | 2654-1459 |
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